146: Boosting Vaccine Uptake

ASTHO and the de Beaumont Foundation release early results of a new survey of America’s public health workforce; ASTHO Chief Medical Officer Dr. Marcus Plescia says there are steps public health departments can take to address lagging COVID-19...

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ASTHO and the de Beaumont Foundation release early results of a new survey of America’s public health workforce; ASTHO Chief Medical Officer Dr. Marcus Plescia says there are steps public health departments can take to address lagging COVID-19 vaccine uptake; Alabama State Health Officer Dr. Scott Harris says telehealth is a lifeline for doctors and hospitals in rural areas; and today is National Doctors Day.

ASTHO News Release: National Survey – Public Health Professionals Pushed to Limit

FDA News Release: FDA Authorizes Second Booster Dose of Two COVID-19 Vaccines for Older and Immunocompromised Individuals

ASTHO Public Health Review Podcast

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This is Public Health Review Morning Edition for Wednesday, March 30th, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.


The COVID-19 pandemic is taking a toll on America's public health workforce, and now there's research that proves it. According to a new survey of almost 45,000 people in state and local health departments, more than half report at least one symptom of post-traumatic stress disorder.

ASTHO and the de Beaumont foundation worked together on the survey, gathering data between September and January. De Beaumont CEO Dr. Brian Castrucci is here Friday to talk about the findings and what they mean for the future of public health. You can read the news release now using the link in the show notes.


COVID-19 vaccines are making headlines again as the federal government approves a second booster for people age 50 and older. We wanted to get ASTHO's take on the plan and understand how public health can work through a reported lag in vaccine uptake. Here's ASTHO chief medical officer Dr. Marcus Plescia with today's morning conversation.

What's your take on a second COVID-19 booster shot for older adults?


The issue here is that we do know that respiratory viruses—coronavirus and COVID, all of these respiratory type viruses—what we know from the past is that the immunity we get either from a vaccine or from previous infection isn't long lasting. And so, the concern is people get infected, or they get a vaccine and a booster, and then that immunity starts to wane. So the question is, how often do you offer another opportunity to boost that immunity and what are the trade-offs with that? And I think that's what the controversy is right now.

And so, the decision was made that can authorize it. People who want to do that will be able to get the vaccine. People who don't, aren't going to, you know, they will still be considered up-to-date with vaccination, regardless of whether they decide to do this.


We've heard that vaccine uptake is at its lowest level since vaccines were first available in December of 2020. As this new booster appears ready to hit the market, what's the challenge for public health given the apparent disinterest we see right now in vaccination?


I think what we're seeing is vaccine hesitancy. I think we're getting up to a point where we vaccinated people who are enthusiastic and willing to participate in this, but there's a sector who—they're not necessarily against it, they're just a little hesitant, they're reluctant, they don't understand it for whatever reasons. And I think that's what we've been hitting up against.

I think with making the vaccine available for a fourth dose, we're going to see a lot of uptake. I mean, there are a lot of people who got the first three who are going to be enthusiastic to get a fourth, they just don't want to get COVID.

But I think we are going to need to circle back. I mean, we still have 25% of the population who hasn't had any vaccine at all. We've got a number of people who got the first two who didn't get the third. The science is pretty good that this probably should be a three-dose vaccine. You know, the science is pretty good. Getting the first booster makes a lot of sense, and I think we need to do a little work to bring people around to that


In terms of bringing people around, is there anything more that can be done there?


There are two things that we're suggesting to our members in their leadership roles. One of the things that we know that there's an evidence base for around vaccine hesitancy is that being advised by your medical care provider to do something makes you much more likely to overcome that hesitancy. People trust their doctors.

So, one of the things we're suggesting is let's continue to enroll more and more doctors into the COVID vaccination campaign. We don't have widespread participation by the medical community in this, mostly because there's been a limited supply. So, one thing we're suggesting is, you know, keep pushing those efforts to get more and more doctors and doctors' practices enrolled.

The second thing we're suggesting—which is a little more complicated and challenging, and there's some capacity issues—is, you know, can we start using our immunization surveillance system or our vaccine registries where we count up who's gotten vaccinated, can we start using those in a reciprocal way? Whereas rather than just getting data from medical practices, we offer that data back. You can link your patient roster to the vaccine registry to find out who's been vaccinated, who hasn't.

Since most people weren't vaccinated their doctor's offices, most doctors just have no idea it when somebody walks in the door, if they are, they aren't. If you know that information, you can do outreach, and I think that could be very valuable for us as well. So we'd have doctor's offices not only offering the COVID vaccine, but also taking fairly proactive steps to get people to come in and talk to them about getting vaccinated, because we know that are not vaccinated so far.

So, those are two very tangible things we're going to begin suggesting to some of our members. Many of them were already doing it, but it's—I think it's a place we could see some benefits.



Telehealth has been a game changer for many people left isolated during the pandemic. Expanded flexibility with federal rules governing healthcare services delivered online has kept many people engaged with their providers. Alabama state health officer Dr. Scott Harris says it's also been a lifeline for doctors and hospitals in rural areas.


We see younger physicians who are coming out of training, they're used to having lots of medical specialists around them. And to have them in a rural area where they don't have that specialty support, it makes it really difficult for us to get them to stay in those areas.

And so, having telehealth services available for their patients is really important to maintaining those providers in those communities. And it's exactly the same explanation for rural hospitals themselves. Our rural hospitals in Alabama are really struggling in a lot of different ways. And so, telehealth is a way for them to continue to provide a broad range of services that they might not otherwise have available.


Hear the full conversation on a new episode of the Public Health Review podcast, available soon everywhere you stream audio.


Speaking of doctors, today is National Doctors' Day. The commemoration started in 1933 with people mailing greeting cards to doctors. It became official in 1990 when Congress and President George H.W. Bush passed a law marking the day. So, if you know a doctor, today is a good day to say "thank you" for the work they're doing to keep us all healthy and safe.


Before we go, we want to remind you to leave us a rating and a review—they help raise our profile, and that makes it easier for new listeners to find us online. Also, if you follow the show, you'll never miss a single report. You can do all of this on the channel you're listening to right now.


That'll do it for today's newscast. We are back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Scott Harris MD, MPH, FACP, FIDSA

State Health Officer, Alabama Department of Public Health

Marcus Plescia MD MPH

Chief Medical Officer, ASTHO